Helping the Most Vulnerable

Faculty in the Department of Health Oucomes and Implementation Science employ rigorous science to help the most vulnerable in our society, including children, low-income families, those who have experienced health disparities and those with chronic conditions and comorbidities. Below you will find a small selection of stories about our efforts in these arenas.

Toxic Stress: Uncovering connections between trauma and poor health in children

Scientists have long known that children who experience stressful events are more likely to face health problems as adults; however, a new study from Melissa Bright, Ph.D. and assistant research scientist in the Department of Health Outcomes and Biomedical Informatics, reveals that childhood trauma has drastic and almost immediate effects.

In fact, children exposed to three or more acutely stressful events are six times more likely to suffer from a mental, physical or learning disorder than children who did not face traumatic experiences.

Bright, who analyzed data from nearly 96,000 children across the United States, believes the culprit could be chronic toxic stress, which can alter children’s developing brains and immune systems, making it more difficult for them to fight disease and cope with additional stressors.

“Many of these children have been exposed to wave after wave of difficulty, affecting their health and behavior in ways we’re just beginning to uncover,” explained Bright. “In order to prevent the most severe long-term effects, we have to tackle this issue holistically, working with families, physicians, law enforcement, teachers and policymakers to discover the root causes and take steps to protect these children.”

Researchers: Bright M, Knapp C, Hinojosa MS, Bonner B, Alford S

Navigating Toward Change: A large-scale pragmatic clinical trial for individuals with co-occurring mental and physical conditions

The Wellness Incentive and Navigation (WIN) pragmatic clinical trial aims to improve the health of adults on Medicaid with both physical and mental conditions and decrease unnecessary health care use through a three-year, real-world research study. In particular, health navigators seek to address the gap between these adults’ goals and their actions by increasing understanding of their role in their health care and equipping them with the skills, knowledge, and confidence to take on that role—a technique referred to as motivational interviewing. Health navigators use motivational interviewing to help guide these adults’ use of a flexible wellness account, which allows them to purchase health-related items such as a gym membership or tennis shoes.

“In this project, they pick their goals, they pick their resources, and they pick how they are going to spend their money, and I really think that’s what’s going to change the game,” said Ebony Kimario, a health navigator with WIN and Molina Health Care in Texas. “It’s not some professional coming in and saying this is how you should live your life. It’s a professional coming in and saying, ‘What do you think?’ and they aren’t used to that.”

The trial, which is one of 10 funded by the Center for Medicare and Medicaid Innovation, seeks to determine whether the combined intervention of health navigators and patient-directed flexible wellness accounts is more effective than the usual care received through a Medicaid Managed Care Plan. A fundamental part of this intervention is a commitment to patient autonomy and patient-centered care.

Researchers: Shenkman EA (PI)

Teen Dating Violence: The role of aggression, gender, alcohol and drugs

In an examination of 2,991 high-risk 12th graders in Chicago, marijuana use multiplied by 15 times the likelihood of being both a victim of dating violence and committing acts of aggression, while a combination of marijuana and alcohol use increased this co-occurrence by eight times. Therefore, researchers suggest that efforts to address teenage violence systematically approach this nexus of problems, acknowledging the roles of substance use as well as the overlap of violent acts and victimization in adolescents.

Researchers: Reingle JM, Jennings WG, Maume MO, Komro KA

Risky Partners

Faculty members in the Department of Health Outcomes and Biomedical Informatics found certain factors decreased the likelihood of young women using condoms. Any one of the following decreased the likelihood of condom use by 40 percent: if the couple met in public, their partner was three or more years older or he consumed alcohol prior to sex. A combination of two or more of these factors decreased condom use by 70 percent. Helping young women recognize their partners’ influence on condom use could help prevent sexually transmitted infections among youth.

Researchers: Staras SA, Livingston MD, Maldonado-Molina MM, Komro KA